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PubMed2003

External cephalic version after rupture of membranes in early labor.

BACKGROUND: Breech presentation occurs in approximately 4% of term pregnancies. Recently the American College of Obstetrics and Gynecology has suggested that cesarean section is the safest option if the fetus remains in breech position. As an alternative to cesarean section, external cephalic version has been used prior to labor and even recently in the patient with rupture of membranes not in labor. We present two cases found at our institution from 1990 through 2001, who at term presented in early labor with spontaneous rupture of membranes and underwent successful external cephalic version. CASE: Two women presented to labor and delivery with spontaneous rupture of membranes and were found to be in early labor with cervical dilatation. Both underwent successful external cephalic version. As labor progressed, each ultimately underwent cesarean section to accomplish delivery. One patient underwent cesarean section for failure to progress and the other for severe variable decelerations associated with an umbilical cord prolapse. CONCLUSION: External cephalic version is possible in the term pregnancy with ruptured membranes and in early labor, but the patient remains susceptible to complications of version and labor.

Adult↗
PubMed1976

Station of the fetal presenting part. VI. Arrest of descent in nulliparas.

The specific labor aberration of arrest of descent was investigated in 253 nulliparas. It was found to be associated with fetopelvic disproportion in 52%. Delivery outcome was adversely affected by such factors as high fetal station at time of arrest and long duration of arrest. Arrest of descent occurring during the administration of oxytocin infusion was particularly ominous, no patient subsequently delivering vaginally. The best delivery prognosis was seen in those cases in which apparently causative inhibitory agents, including peridural anesthesia and sedation, were allowed to abate expectantly. Neither immediate operative delivery nor expectancy (other than in the specific abatement cases) was determined to be an appropriate approach to resolving this problem. Postarrest progression, especially if at a rate that was the same as or greater than prearrest descent, proved to be a favorable sign for delivery outcome. Neonatal depression and birth trauma were closely correlated with midforceps procedures, especially when done in conjunction with forceps rotation. Cephalopelvic disproportion yielded poor perinatal results, particularly among those delivered vaginally by instrumental means. Uterotonic stimulation of labor to correct the arrest problem therapeutically also had an adverse effect on the fetus when followed by operative delivery. Based on these observations a program of management was evolved for treating patients with arrest of descent.

Adult↗